tbuckley/cabot-search huggingface dataset:
Abstract 13297: Higher Maternal Serum Ferritin in the Third Trimester is Associated With Reduced Endothelial Function in the Preadolescent Child
Authors: Cleighton Boehme, Martha Moran, Victor Do, Juliana Lasso-Mendez, Rhonda C Bell, Stephane L Bourque, Deborah S Fruitman, Christy-Lynn Cooke, Lisa K Hornberger
Journal: Circulation (2022)

Introduction: Elevated iron status in pregnancy has been implicated in gestational diabetes (GDM) development and in cardiovascular (CV) disease progression in adults. Animal models, however, have suggested maternal iron deficiency anemia may increase the offspring’s risk of CV disease. Whether maternal iron levels impact the CV health of the child in humans is unknown. This study investigated the relationship between maternal iron markers and the child’s CV health. Methods: This is a nested observational study tied to the Alberta Pregnancy Outcomes and Nutrition (APrON) Study. Children of mothers with and without GDM but otherwise uncomplicated pregnancies were prospectively recruited. Maternal serum ferritin, total iron binding capacity, and hemoglobin in the 2 nd and 3 rd trimesters were obtained. CV outcomes included: left ventricular mass Z-score, reactive hyperemia index score (lnRHI, EndoPAT), Doppler-based aortic and peripheral arterial pulse wave velocity, and carotid intima-media thickness. Univariate and multiple linear regression models, including maternal GDM as a covariate, were built to explore relationships between maternal iron markers and the child’s CV health. Results: Fifty-two children, 40 (77%) female, were assessed at a mean age of 10.9±0.7 years. Maternal serum ferritin in the 2 nd (median (IQR): 38.8 (39.2) ng/mL; B=-0.0039, p=0.01) and 3 rd trimesters (13.7 (9.0); B=-0.011, p=0.008) inversely related to the child’s lnRHI in univariate analyses, whereas no other relationships were observed between maternal iron markers and the child’s CV health. While the effect of 2 nd trimester serum ferritin was attenuated in a multiple linear model adjusting for maternal GDM, another model demonstrated a persistent relationship of 3 rd trimester serum ferritin with lnRHI (B=-0.028, p=0.007), not impacted by maternal GDM (B=-0.37, p=0.11) or their interaction term (B=0.020, p=0.07). Conclusions: High maternal serum ferritin in the 3 rd trimester may be associated with reduced endothelial function of the child. If validated, further work is needed to understand pathogenic mechanisms, and the impact of supplementation guidelines in pregnancy.
Abstract 12864: Nuclear Magnetic Resonance Lipoprotein Particle Subclasses Associate With Chronic Inflammatory Related Diseases Differently Than Cardiovascular Diseases: The Multi-Ethnic Study of Atherosclerosis
Authors: Edward K Duran, David R Jacobs, Aruna D Pradhan, Aaron W Aday, Daniel A Duprez
Journal: Circulation (2022)

Introduction: Chronic inflammatory related disease (ChrIRD) is a novel outcome capturing non-cancer, non-cardiovascular clinical events driven by subclinical inflammation. Derangements in triglyceride-rich, low-density, and high-density lipoprotein particle (TRLp, LDLp, HDLp) subclass concentrations known to associate with inflammation and future cardiovascular disease have not been extensively evaluated in ChrIRD. Hypothesis: Lipoprotein particle subclasses may predict future ChrIRD in a similar direction and magnitude as with CVD. Methods: We measured 17 lipoprotein subclass particle concentrations by NMR spectroscopy in the Multi-Ethnic Study of Atherosclerosis (MESA). MESA is a US cohort including 6,759 White (38.6%), Chinese (11.9%), Black (27.6%), and Hispanic (22%) men and women initially aged 45-84 years and free of CVD. Participants were contacted at least annually to ascertain clinical events. Incident CVD (MI, Stroke, PAD, CV Death) and ChrIRD death/hospitalization risk per-quartile of lipoprotein marker levels were evaluated using disease-specific multivariable Cox regression models adjusted for traditional risk factors. Results: Disparate risk associations with ChrIRD and CVD were observed (Figure). Elevated small HDLp, total LDLp, and small TRLp, and were inversely associated with ChrIRD events. Additionally, larger TRLp size was associated higher ChrIRD risk. Metrics of HDL, LDL, and TRL associations with incident CVD as expected. In contrast, Very large TRLp was inverse with both clinical outcomes (HR [95% CI] CVD: 0.83 [0.75-0.96] ptrend=0.09, ChrIRD: 0.85 [0.69-0.99], ptrend =0.02). Conclusions: TRL, LDL, and HDL particles differentially associate with CVD and ChrIRD. Established predictors of CVD, including total TRL and LDL particles, small LDL, and large /medium TRL, may be inert or even protective in development of ChrIRD events due to distinct pathophysiologic contributions that warrant further investigation.
Abstract 14089: CT Analysis of Small Pulmonary Vessels and Its Association With Pulmonary Function Tests and Prognosis in Pulmonary Hypertension
Authors: Yousef Shahin, Juerg Tschirren, David Kiely, Andrew J Swift
Journal: Circulation (2022)

Introduction: The in vivo relationship between small pulmonary vessels (SPV) and pulmonary hypertension (PH) and its association with pulmonary function and prognosis in PH is not fully understood. Hypothesis: The morphological change in SPV volumes (SPVV) can be quantitatively estimated from CT pulmonary angiography (CTPA) in different subtypes of PH and is associated with pulmonary function metrics and prognosis in PH. Methods: : In this retrospective single center study performed from January 2008 to February 2018, quantitative CTPA analysis of total SPVV (TSPVV) (0.4-2mm vessel diameter) was performed using VIDA Diagnostics software (LungPrintTM, VIDA Diagnostics, Inc., Coralville, IA, USA). Results: 1823 patients (mean (SD) age 69 (13) years, 65% females) were analysed. 1593 patients with PH (mPAP = 43 (13) mmHg) were compared to 230 patient controls (mPAP=20 (3) mmHg). Mean small vessel volumes at a diameter below 2 mm were lower in PAH and PH associated with left heart disease compared to controls (-4.3 (-8 to -0.1) ml for 1.6 mm vessels, p=.03 and -6.8 (-11 to -2) ml, p&lt;.001, respectively). In patients with PH, the most significant positive correlation was noted with FVC%predicted (r=0.30-0.40, all p&lt;.001). Median survival for TSPVV≤1.2mm greater than 50 ml was longer than TSPVV≤1.2mm less than or equal 50 ml (85 versus 71 months, 95% C.I 73-97, p=.02, respectively). Median survival for TSPVV&gt;1.2mm greater than 135 ml was longer than TSPVV&gt;1.2mm less than or equal 135 ml (88 versus 72 months, 95% C.I 73-98, p=.02, respectively). TSPVV≤1.2mm greater than 50 ml (HR 0.851, p=.02) and TSPVV&gt;1.2mm greater than 135 ml (HR 0.839, p=.02) were significant predictors of mortality on univariate analysis. TSPVV≤1.2mm greater than 50 ml (HR 0.785, p=.04) was independent predictor of mortality on multivariate analysis in addition to age, Male gender, mRAP, PVR and SvO2. Conclusions: The morphological change in small vessels can be successfully quantified from CTPA in different subtypes of PH and is associated with pulmonary function metrics and prognosis in PH.
Abstract 14113: Atrial Fibrillation Associated With Differences in Proteomic Composition of Retrieved Acute Ischemic Stroke Emboli
Authors: Sajal Medha K Akkipeddi, Redi Rahmani, Derrek Schartz, Siddharth Chittaranjan, Aditya Gunturi, Nathaniel Ellens, Gurkirat Kohli, Tarun Bhalla, Thomas Mattingly, Craig Morrell, Matthew T Bender
Journal: Circulation (2022)

Introduction: Study of the composition of acute ischemic stroke emboli is still in infancy, though recent literature has begun to demonstrate remarkable heterogeneity in the composition of ischemic stroke emboli from different etiologies. Atrial fibrillation (AF) is a significant risk factor for stroke, and so in this study we investigate differences in proteomic composition between retrieved stroke emboli from patients with and without AF. Methods: The full proteomic composition of retrieved thromboembolic material from 24 patients with AIS was evaluated by mass spectrometry. The abundance of individual proteins in patients with AF was compared to that of patients without AF using Mann-Whitney U-tests, with significant differences described by the fold change (FC) in abundance. Cut-offs for significance were set at p = 0.05 and an FC difference of 2x. Descriptive heatmaps with sorted dendrograms were generated using the proteins with significant FC differences between patients with and without AF. Results: Proteins with the greatest FC enrichment in emboli from patients with AF included ferritin light chain (p = 0.006), ferritin heavy chain (p = 0.003), eosinophil peroxidase (p = 0.01), eosinophil lysophospholipase (p = 0.02), eosinophil-derived neurotoxin (p = 0.02), the neprilysin modulator nicastrin (p = 0.0007), HLA class I B α chain (p = 0.02), among others. Notably, neutrophil and histone proteins were also significantly enriched in emboli from patients with AF (p &amp;lt; 0.05 for all). Proteins with the greatest FC enrichment in emboli from patients without AF included interferon-induced GTP-binding protein Mx1 (p78) (p = 0.04) and mitsugumin-53 (p = 0.03). Conclusions: This data demonstrates that clot composition may directly reflect underlying stroke etiology. More specifically, the enrichment of eosinophil, neutrophil, and histone proteins in emboli from patients with AF points to significant immunothrombosis in emboli from this patient population. These findings may underlie distinct mechanisms in clot formation or maintenance in AF, and inform not only future studies on stroke pathophysiology, but also future work on novel pharmacotherapies for acute ischemic stroke in this patient population.
Abstract 14180: Characteristics and In-Hospital Outcomes of Haemochromatosis in Heart Failure
Authors: Raheel Ahmed, Akil A Sherif, Selma Mohammed, Saurabh Deshpande, Hassan Khan, Syed Emir Irfan Wafa, Virend K Somers, Hiroyuki Sawatari, Deepak Padmanabhan, Mohammed Khanji, Anwar Chahal
Journal: Circulation (2022)

Introduction: Cardiovascular complications are the main contributors towards morbidity and mortality in hemochromatosis. Iron overload can cause arrhythmias and heart failure (HF). There is a paucity of data on haemochromatosis and the burden of HF and its sequalae. Hypothesis: To determine characteristics of HF patients with and without haemochromatosis, and in-hospital outcomes (mortality, length of stay (LOS), mechanical circulatory support, and cardiac transplantation). Methods: Patients with HF, with and without hemochromatosis, were identified from the Nationwide Inpatient Sample Database. Results: Between 2016-2019, 2,940 (0.06%) of 4,823,994 HF patients had hemochromatosis. The hemochromatosis cohort was younger (mean age, 68 vs 71 years), predominantly men (63% vs 52%), White (77% vs 64%), and had less cardiovascular comorbidity burden (coronary artery disease (41% vs 51%), atrial fibrillation (45% vs 46%), hypertension (20% vs 24%), hyperlipidaemia (44% vs 53%), diabetes (42% vs 49%) and obesity (18% vs 25%), compared with HF patients without hemochromatosis (p&lt;0.01 for all). However, hemochromatosis patients had a higher concomitant third degree atrio-ventricular block (1.2% vs 0.7%), ventricular tachycardia (7.8% vs 5.4%), ventricular fibrillation (0.5% vs 0.3%), chronic liver disease (24% vs 6%) and anemia (51% vs 37%) [p&lt;0.01]. The hemochromatosis patients had a higher mean LOS (6.1 vs 5.4 days, p&lt;0.01), need for mechanical circulatory support (0.9% vs 0.6%, p&lt;0.01) and cardiac transplantation (0.2% vs 0.1%, p&lt;0.01). Mortality (2.0% vs 2.7%, p=0.09) was comparable between the groups. Conclusion: Despite younger age and lower burden of cardiovascular comorbidities, patients with hemochromatosis had a higher burden of arrhythmias, need for mechanical circulatory support and cardiac transplantation and a higher LOS. This warrants the need to devise early management strategies for HF patients with hemochromatosis.
Abstract 13969: Iterative Changes in Alcohol Septal Ablation at the Medical University of South Carolina: A Single-Center Experience
Authors: Ryan Moore, Molly Silkowski, William C Mostertz, Matthew Evans, Chris Nielsen, VALERIAN Fernandes
Journal: Circulation (2022)

Introduction: Alcohol septal ablation (ASA) is an effective procedure to treat medically refractory hypertrophic obstructive cardiomyopathy (HOCM). Several modifications have been made to the procedure since its inception. We seek to assess the changes in the procedure and outcomes over the past 20 years Methods: We retrospectively analyzed 845 ASA procedures performed from January 2000 to February 2022 using an internally maintained database. These procedures were then split into three groups, with procedures occurring from 2000-2004 (Cohort 1), 2005-2011 (Cohort 2), and 2006-2022 (Cohort 3). Patient demographics, echocardiographic measurements, and procedural data were recorded. Results: Average patient age was 53.06 (143:161 M:F, 52.96% female), 59.71 (125:140, 52.83% female), and 63.86 years (99:177, 64.13% female) in Cohorts 1, 2, 3 respectively. The peak resting left ventricular outflow tract (LVOT) gradient was significantly higher in Cohort 2 and 3 (69.893 mmHg, 72.218 mmHg) versus Cohort 1 (57.32 mmHg, p&lt;0.0001). The number of septal arteries injected increased slightly, but the total amount of alcohol injected decreased, thereby implying a reduced amount of alcohol injection per septal artery. The overall infarct size did not show a significant difference between the three Cohorts (peak total creatine kinase, p=0.0871). The average length of hospital stay decreased and pacemaker incidence continued to be &lt;10%. There were no procedural deaths since 2008. See Figure 1. Conclusions: ASA has become increasingly safer over the past twenty years at MUSC with maintained efficacy and zero procedural mortality since 2008. Improved patient selection, transition to a bi-radial approach, contrast echocardiographic imaging, slower alcohol injection rate, reduced alcohol volume per septal artery and increased operator experience are responsible for the improvement.
Abstract 13228: Cannabis Inhalation Reduces Muscle Sympathetic Nerve Activity in Humans
Authors: Christian P Cheung, Massimo Nardone, Jordan B Lee, Ryleigh E Baker, Philip J Millar, Jamie F Burr
Journal: Circulation (2022)

Introduction: Despite widespread use, the neuro-cardiovascular responses associated with cannabis use remain incompletely understood. Acute increases in heart rate, which are abolished under beta-adrenoreceptor blockade, suggest cannabis increases cardiac sympathetic activity; however, its effects on peripheral sympathetic outflow have not been measured. The objective of this work was to quantify direct recordings of efferent post-ganglionic muscle sympathetic nerve activity (MSNA) following cannabis inhalation. Hypothesis: MSNA would be increased following cannabis inhalation. Methods: Blood pressure (BP), heart rate, and MSNA measured from the fibular nerve, were recorded in seventeen young, healthy participants (22±3y: 8F) for a 10-minute epoch before and after inhalation of aerosolized dry cannabis flower (100mg, 13.6% THC). Cardiac output was estimated from finger photoplethysmography (Modelflow method). Arterial baroreflex control of MSNA was quantified using the slope of the weighted linear regression between diastolic BP and MSNA. Results: Mean BP (79±7 vs. 84±8mmHg), heart rate (61±7 vs. 81±14bpm), cardiac output (4.8±1.1 vs. 6.8±2.5L/min), and total vascular conductance (50±11 vs. 71±26mL/min/mmHg) were increased, while MSNA burst frequency (17±7 vs. 8±6bursts/min), incidence (29±11 vs. 11±9bursts/100hb), and amplitude (38.6±6.4% vs. 23.8±8.3%), and sympathetic baroreflex sensitivity (-3.9±1.8 vs. -1.5±1.5bursts/100hb/mmHg) were decreased following cannabis inhalation (all P &lt;0.01). The rise in cardiac output was negatively associated with the reduction in MSNA burst frequency (r 2 =0.40; P &lt;0.01). Conclusions: These data demonstrate that MSNA is reduced following acute cannabis inhalation in humans and is mediated, in part, through a baroreflex mechanism.
Abstract 13841: Prevalence and Impact of Recreational Cannabis Use on Acute Ischemic Stroke and Related Mortality in Elderly (≥65 Yrs) Peripheral Vascular Disease Patients: A Population-Based Analysis in the US (2016-2019)
Authors: Rupak Desai, Prerna Bansal, Harika Varma Chintalapalli Patta, Brian BRERETON, Blessy George, Athul Raj Raju, Geethu Jnaneswaran, Bhavyasri Merugu, Jaswanth Jasti, Frailyn Nunez, Gowri Anil Peethambar
Journal: Circulation (2022)

Background: Considering preliminary reports suggesting associations between peripheral atherosclerotic disease (cannabis arteritis) and acute ischemic stroke (AIS) with cannabis use disorder (CUD), we sought to study the burden and impact of CUD on AIS risk and outcomes in the elderly with PVD. Methods: The National Inpatient Sample (2016-2019) was used to identify geriatric PVD admissions with vs. without CUD . We compared the burden and risk of AIS admissions with vs. without CUD and subsequent in-hospital mortality using adjusted multivariable regression analyses. Results: Of 5,115,824 total geriatric admissions with PVD (50.6% males, 77.5% white), 21,405 had CUD. The prevalence of DM was lower in the CUD cohort (19.7% vs 33.7%) with comparable rates of HTN and smoking between groups [Table 1]. Concomitant drug use was higher in CUD vs non-CUD cohort. There was AIS period prevalence of 5.2% in CUD vs 4.0% in non-CUD cohorts (p&lt;0.001). Among geriatric PVD patients, CUD was associated with higher odds of AIS hospitalizations aOR 1.34 (95%CI 1.18-1.52, p&lt;0.001) without a statistically significant difference in subsequent all-cause in-hospital mortality (aOR 0.71, 95%CI 0.36-1.37, p=0.302). Elderly PVD patients with HTN (aOR 1 .73) predicted higher risk of AIS, however, interestingly, concomitant tobacco use disorder revealed a paradox protective effect while assessing the predictors of AIS in elderly PVD patients with CUD (aOR 0.58 95CI 0.42-0.79, p&lt;0.001). Conclusions: There is a 34% risk of AIS in Geriatric PVD patients with CUD even after controlling for CVD risk factors and drug abuse. Future studies are warranted to explore and confirm the observed smoker’s paradox.
Abstract 13414: Promoting Health Equity Using a Hybrid Virtual Cardiac Rehabilitation Program
Authors: Trent B Johnson, Nino Isakadze, Lena Mathews, Yumin Gao, Zane MacFarlane, Erin Spaulding, Seth S Martin, Francoise A Marvel
Journal: Circulation (2022)

Background: Cardiac rehabilitation (CR) is an effective program for the secondary prevention of cardiovascular disease. Novel CR delivery methods are needed to increase access in an equitable and cost-effective manner. Herein, we present lessons learned in developing and implementing our hybrid CR program. Methods: We established a 5-step approach to increase engagement in CR using a hybrid in-center and virtual model: 1-Assemble a Team and Technology Platform Develop a team with diverse perspectives and integrate technology to facilitate patient participation. 2-Establish an Equitable Onboarding Process Combine patient navigators with video tutorials to support equitable access for patients at different levels of digital literacy. 3-Gather Feedback Conduct design sessions to elicit feedback. 4-Implement Feedback Use quality improvement (QI) protocols to iteratively improve onboarding and refine logistics. 5-Evaluate Clinical Efficacy Conduct studies to investigate the program's efficacy in improving outcomes. Results: In step 3, we used human centered design (HCD) to solicit feedback from patients, caregivers, and clinician stakeholders to influence the creation of our program. Our patient sample was 27% African American, 9% Asian, 18% Hispanic or Latino, 55% female, with a median (IQR) age of 63 (56-66) years. Feedback led to the creation of a video on CR benefits, the introduction of motivational coaches, and the creation of an EPIC order set. In step 4, using QI, we were successful in promoting equitable access as demonstrated by the fact that the patients had a mean age of 59.2 (SD: 10.4) years, 40% were female, 39% were of minority race/ethnicity, 58% were insured by Medicare/Medicaid. Conclusions: Our novel hybrid CR program shows promise for improving CR. Future directions (Step 5) include evaluation of the program in an mTECH REHAB Trial as part of AHA’s Strategic Focused Research Network.
Abstract 13825: Clinical and Echocardiographic Outcomes Associated With Early Initiation of Beta Blockers Use Among Patients With Recently Diagnosed Non-Ischemic Cardiomyopathy Treated With a Wearable Cardioverter Defibrillator
Authors: Ido Goldenberg, Moghniuddin Mohammed, Mehmet K Aktas, Wojciech Zareba, Scott McNitt, Valentina Kutyifa
Journal: Circulation (2022)

Introduction: Beta-blocker (BB) therapy was shown to improve clinical outcomes among heart failure patients with reduced ejection fraction. However, there are limited data on the efficacy of BB use among patients with recently diagnosed non-ischemic heart cardiomyopathy (NICM) who are treated with the wearable cardioverter defibrillator (WCD) until a decision on the need for an ICD is made. Aim: Determine if BB use is associated with improved outcomes in patients with NICM treated with the WCD. Methods: The study population comprised 1195 patients with recently diagnosed NICM enrolled in the prospective WEARIT-II Registry. Clinical data, arrhythmia events, ICD implantation, and improvement in left ventricular ejection fraction (LVEF) were captured. Multivariate logistic regression was used to estimate the odds ratio (OR) of LVEF improvement to &gt;35% by BB usage. The risk of death at 1-year by BB use was assessed using a multivariate cox-proportional hazards modeling. Results: Patients treated with BBs at baseline were more likely to experience an improvement in LVEF to &gt;35% that patients who did not receive treatment with BB (43% vs 29%, respectively; adjusted OR=1.67 95% CI [1.15-2.41] p=0.007; Figure: panel A and were less likely to receive an ICD at the end of the WCD use (37% vs 47%; adjusted OR=0.64 95% CI [0.46-0.90] p=0.024; Figure: panel B). At 12 months of follow-up the probability of death was significantly lower among patients who received BB therapy during WCD use vs. those who did not.,(p=0.007 Figure: panel C), corresponding to a significant 59% lower risk of death at one year associated with early BB use (adjusted HR=0.41 95% CI [0.21-0.80] p&lt;0.01). Conclusions: Among patients newly diagnosed NICM who are treated with a WCD until a decision on the need for an ICD is made, early initiation of BB is independently associated with a greater likelihood of improvement in EF, a lower probability of needing an ICD at end of WCD use, and a lower risk of death at 1-year.